Medicaid Audit

Any Medicaid provider is subject to being investigated and audited in the event there are suspicious anomalies in its claims or billing practices. When a Medicaid Program sends notice of an audit, it requires correct responses and thorough documentation. The assistance of experienced, legal counsel should be sought from the beginning to ensure compliance.

It’s not just healthcare providers who commit Medicaid fraud either. Individuals can try to qualify for the many benefits of Medicaid by lying about their income and producing fraudulent documents. Many people also do not realize that recipients of Medicaid have a duty to update financial eligibility information immediately if income changes occur. If you do not notify the government that your income has changed and you are ineligible to receive benefits, you could be convicted of committing fraud. The most common types of Medicaid fraud are: billing for services that were not provided or giving unnecessary services; selling prescriptions; ordering unnecessary tests; and giving money to consumers in exchange for medical care.

Many agencies in New York help monitor and investigate Medicaid fraud. Investigators also split up their duties on different levels, based on degrees of difficulty. The lower level focuses on applications for welfare programs and determining whether the applicants are eligible and honest. The next level is investigations on the improper receipt or dissemination of welfare or Medicaid funds. If Medicaid fraud rises to the level at which criminal charges are brought, many investigators will work with state and federal prosecutors to strengthen their case.

If someone is convicted of Medicaid fraud in New York, the punishments vary from jail time to fines and restitution. If you have no criminal record and the facts of your case show minimal fraud or mild violations, you will be less likely to go to jail. Most Medicaid cases in New York are charged as felonies with Grand Larceny and Welfare fraud. Hiring a good lawyer can help you get the charge reduced to a misdemeanor, and even avoid jail time. One recent case included 9 New York doctors that made nearly $7 million by taking advantage of homeless people. The indictment listed charges of health fraud, enterprise corruption and money laundering. The operation worked by sending recruiters to offer free shoes to homeless people – the focus was on homeless shelters and soup kitchens. Once the patients came into the clinic, a podiatrist would examine them, and give them a fake diagnosis, ordering shoes or orthotics that patients did not actually need. Then referrals would be made, additional tests ordered and follow-up appointments scheduled. After that, patients could then pick a pair of shoes from a storeroom in the clinic.

Medicaid fraud takes advantage of a system designed to help the most disadvantaged quarters of society. Some individuals attempt to take advantage of the system, which can result in jail time. When businesses or healthcare providers take advantage, they are usually profiting heavily off the backs of the vulnerable, and these actions will generally garner tougher jail sentences and higher fines. If you receive notice of a Medicaid audit, it’s crucial to seek the advice of an experienced attorney familiar with the details of Medicaid. They will ensure you respond appropriately to the audit, and defend you in the hope that you will receive a less harsh sentence.